Al-Abdulla Nael A, Thompson John T, Sjaarda Raymond N
The Wilmer Eye Institute of the Johns Hopkins Hospital, Baltimore, Maryland. Retina Specialists, Baltimore, Maryland 21204, USA.
Ophthalmology. 2004 Jan;111(1):142-9. doi: 10.1016/j.ophtha.2003.05.005.
To evaluate the results of idiopathic macular hole surgery with or without epiretinal dissection or peeling of the internal limiting membrane (ILM).
Retrospective consecutive nonrandomized comparative interventional trial.
One hundred seventy-two eyes of 162 patients with previously untreated idiopathic macular holes of <24 months duration.
All eyes were treated with pars plana vitrectomy by 1 surgeon using 1 of 3 techniques: no epiretinal dissection (116 eyes), epiretinal dissection (27 eyes), or ILM peeling (29 eyes).
Closure of the macular hole and visual acuity.
The macular hole was closed with 1 surgery in 92.9% of 56 eyes with epiretinal dissection/ILM peeling versus 79.3% of 116 eyes without dissection (P = 0.03) and was closed with 1 surgery in 85.1% of 27 eyes in the epiretinal dissection group compared with 100% of 29 eyes in the ILM peeling group (P = 0.05). Visual acuity improved 3 or more lines in 57.1% of 56 eyes in the epiretinal dissection/ILM peeling group compared with 38.8% of 116 eyes in the no dissection group 3 months postoperatively (P = 0.03). Visual acuity improved 3 or more lines at 3 months in the no dissection group in 32.2% of 87 eyes placed faceup for 24 hours compared with 58.6% of 29 eyes placed immediately prone postoperatively (P = 0.02). The visual and anatomic results of the no dissection and epiretinal dissection/ILM peeling groups were similar when comparing eyes in the no dissection group placed immediately prone with the epiretinal dissection/ILM peeling eyes also placed immediately prone. Visual improvement of 3 or more lines at 3 months occurred in 79.2% of 24 eyes in the epiretinal dissection group versus 44.8% of 29 eyes in the ILM peeling group (P = 0.01) in eyes with successful macular hole closure. Visual acuity results were similar in all subgroups at the final examination after reoperations.
The faceup position for 24 hours using adjuvants reduced the initial anatomic and visual outcomes of macular hole surgery. Internal limiting membrane peeling improved the likelihood of successful macular hole closure but reduced the amount of initial visual improvement at 3 months compared with epiretinal dissection alone. Final visual acuities were similar in all groups.
评估有无视网膜前膜剥离或内界膜（ILM）剥除的特发性黄斑裂孔手术效果。
回顾性连续非随机对照干预试验。
162例特发性黄斑裂孔患者的172只眼，病程均小于24个月且未经治疗。
所有患眼均由1名外科医生采用3种技术之一行玻璃体切除术：不进行视网膜前膜剥离（116只眼）、视网膜前膜剥离（27只眼）或ILM剥除（29只眼）。
黄斑裂孔闭合情况及视力。
视网膜前膜剥离/ILM剥除组56只眼中92.9%的患眼在1次手术后黄斑裂孔闭合，而未行剥离组116只眼中这一比例为79.3%（P = 0.03）；视网膜前膜剥离组27只眼中85.1%的患眼在1次手术后黄斑裂孔闭合，而ILM剥除组29只眼中这一比例为100%（P = 0.05）。视网膜前膜剥离/ILM剥除组56只眼中57.1%的患眼术后3个月视力提高3行或更多，未行剥离组116只眼中这一比例为38.8%（P = 0.03）。术后面朝上放置24小时的未行剥离组87只眼中32.2%的患眼在3个月时视力提高3行或更多，而术后立即俯卧位的29只眼中这一比例为58.6%（P = 0.02）。将未行剥离组中术后立即俯卧位的患眼与视网膜前膜剥离/ILM剥除组中术后也立即俯卧位的患眼进行比较，未行剥离组和视网膜前膜剥离/ILM剥除组在视力和解剖学结果方面相似。黄斑裂孔成功闭合的患眼中，视网膜前膜剥离组24只眼中79.2%的患眼在3个月时视力提高3行或更多，而ILM剥除组29只眼中这一比例为44.8%（P = 0.01）。再次手术后最终检查时，所有亚组的视力结果相似。
使用辅助手段面朝上放置24小时会降低黄斑裂孔手术的初始解剖学和视力效果。与单纯视网膜前膜剥离相比，ILM剥除提高了黄斑裂孔成功闭合的可能性，但降低了术后3个月时的初始视力改善程度。所有组的最终视力相似。
